CHOLESTEROL WATCH

Early Statin Use Improves Angioplasty OutcomesA new study from Italy shows that patients who are admitted to a hospital with chest pain have better outcomes with angioplasties if they receive atorvastatin as soon as possible after admission.

The researchers identified 191 patients at risk of heart attack who arrived at the hospital complaining of chest pain. The patients were not taking any chronic statin medication prior to their arrival at the hospital. Physicians usually prescribe statins to patients after a heart attack to help avoid the risk of a second one or serious complications from the first one. Many from these patients will also undergo an angioplasty. For the Italian study, however, half of the 191 patients received atorvastatin in the 12-hour period prior to the procedure.

The study?s lead author, Germano Di Sciascio, MD, director of the department of cardiovascular sciences at the University of Rome, said, ?Even with this short pretreatment, there is improvement in outcomes.? He pointed out that only 5% of the patients who received the statin only before their angioplasty died, had a nonfatal heart attack, or needed another invasive procedure within a month of the angioplasty, compared with 17% of the patients who received the statin only after the procedure. The findings were published in the March 27, 2007, issue of the Journal of the American College of Cardiology.

AHA Recommends Statins For KidsThe American Heart Association (AHA) recommends that statins be part of updated guidelines for treating children and adolescents with high-risk lipid abnormalities, including high cholesterol.

The authors of a scientific statement issued by the AHA said that new data and increased knowledge about the origins of cardiovascular (CV) disease make it necessary to update the current guidelines. They noted that there is now definitive evidence that the atherosclerotic disease process (the building up of plaque on artery walls) begins in childhood, and the rate of progression is greatly increased by lipid abnormalities and their severity.

The authors focused on children with family histories of hypercholesterolemia, diabetes, CV disease, or early heart attacks and stroke. The AHA recommendations include pediatricians screening patients with a fasting lipid profile and using statins as first-line treatment for qualifying children, in addition to lifestyle changes. The statement was published in the April 10, 2007, issue of Circulation.

High Cholesterol Found in Many Stroke PatientsA surprisingly high number of American patients who have a stroke have cholesterol levels that exceed recommended levels, according to the results of research conducted by the Massachusetts General Hospital Stroke Service in Boston. The current cholesterol guidelines were published in 2001 by the National Cholesterol Education Program and revised in 2004, with even lower ideal levels proposed as an option for people with a high risk of cardiovascular disease.

The study assessed the cholesterol levels of 1040 patients hospitalized for stroke or transient ischemic attack (TIA). The researchers found that 27% of the patients had levels of cholesterol that were higher than recommended in the national guidelines.

Eric E. Smith, MD, assistant neurologist at the hospital, said that, since the drugs can reduce the risk of stroke, some of the strokes and TIAs might have been prevented if the guidelines had been followed, which include lifestyle modifications in addition to the use of medications. The findings were published in the February 27, 2007, issue of Neurology.

Moderate Grapefruit Juice Safe for Statin TakersThe results of a 3-month clinical study evaluating the safety of long-term consumption of grapefruit juice in patients who take atorvastatin showed that one 10-oz glass of grapefruit juice a day is safe for those patients taking 40 mg or less of the cholesterol-lowering drug. Previous studies encouraged pharmacists to warn patients taking atorvas-tatin against drinking any grapefruit juice. The recent study showed that, not only did the 10 oz of grapefruit juice produce no increase in adverse effects of atorvastatin, but also the juice actually helped lower low-density lipoprotein levels even more.

The study was conducted at the Watson Clinic Center for Research in Lakeland, Fla. It monitored 154 patients who had already been taking atorvastatin for >3 months prior to the study.

After drinking 10 oz of grapefruit juice daily for 90 days, the patients showed no signs of typical adverse effects associated with atorvastatin, including skeletal muscle toxicity, hepatic toxicity, or reduced quality of life. (The findings were presented in March 2007 at the American Heart Association?s 47th Annual Conference on Cardiovascular Disease Epidemiology and Prevention in Orlando, Fla.)